Question

Phillip is an 80-year old male who presents with dehydration, dry eyes, xerostomia (dry mouth), fatigue, incontinence, sedentary lifestyle, inadequate intake at meals, and weight loss.  Diagnosing diabetes in the older adult is challenging: 50% of patients are asymptomatic or their symptoms are overlooked as side effects of the aging process. Older adults with diabetes can develop mental and physical disabilities as well as increased mortality as a result of this disease. The presence of diabetes increases the risk for the development of hypertension, heart disease, and stroke as well as disorders related to the aging process such as depression, decreased mental function, urinary incontinence, and falls. Diabetes care guidelines for adults include individualization of blood glucose A1c targets.  The American Diabetes Association target of 7% might be too stringent for frail older adults.  For this population, an A1c target of 8% has been deemed more realistic.

1. What conditions/diseases could be causing Phillip’s symptoms and why?
2. Which symptoms could be related to aging? Why?
3. List and define the symptoms that Phillip is suffering as a result of the diagnosis of diabetes.

Answer 1

here,philip seems to have lots of symptoms.let's look at each individual symptom.

1.dehydration

this may be a symptom of diabetes as well as aging.diabetes patients have a typical symptom of polyuria or excessive urination.if the intake of fluid is not enough ,it can easily lead to dehydration.

as you all very well know,it elderly individuals there is always a decrerase in intake of both food and water.

2.dry eyes and xerostomia

i would like to club these symptoms together as they are well known to form part of an autoimmune condition called sjogren syndrome,where the immune system attacks its own body/in this case glands.when the tear producing glands are attacked by autoantibodies destroying them,it can lead to dry eyes,same is true for salivary glands being affected leading to dry mouth/xerostomia.again,these symptoms can be seen in aging also.

regarding xerostomia in diabetes,it is associated with poor glycemic control.Presence of high levels of glucose in blood increases plasma osmotic pressure, which results in tissue dehydration all over the body including mouth. Decreased secretion of saliva adds to the problem of xerostomia.

3.weight loss and inadequate intake at meals

self-explanatory

seen in both diabetes and aging

also in cancer,rapid weight loss is a big clue to diagnosis

inadequate intake may be due to aging,swallowing difficulties(ca esophgus)

4.sedentary lifestyle and fatigue

more towards aging,fatigue also may be due to anaemia

5.incontinence

aging when the bladder musculature is weak

for your reference,i am enclosing symptoms of aging as well as diabetes mellitus taken from harrison's medicine and davidson's book of medicine,most authoritive book in medical practice.

hope this helps,regards